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This study analyzes the morphological and hearing results obtained with cartilage tympanoplasty in retraction pocket, blunting and tympanic membrane lateralization, and cholesteatoma surgeries. Results obtained 3 years postoperatively in 80 patients operated on with cartilage reinforcement of the tympanic membrane (TM) were compared with those obtained 3 years postoperatively in 100 patients operated on with fascia or perichondrium TM reinforcement. Retraction pocket recurrence was found in the patients operated on with fascia or perichondrium in 24% of cases and only in 8% of cases in patients operated on with partial tympanic membrane cartilage reinforcement. No recurrence was found in patients operated on with a total reinforcement of the TM. Cartilage tympanoplasty with skin graft covering the bony external auditory canal (EAC) was performed in 6 cases of severe blunting and/or tympanic membrane lateralization. 3 years post-operatively, good morphological and functional results were obtained in 3 cases. One or two staged ICW procedures were performed in 390 adult patients (416 ears) suffering from a non operated middle ear cholesteatoma. Recurrent and residual cholesteatoma rates were evaluated. Cholesteatomas were operated on with removing the malleus, reinforcing all the tympanic membrane with cartilage and performing an ossiculoplasty with hydroxylapatite prosthesis. The results were compared to those obtained in ICW cholesteatoma surgery with preserving the malleus manubrium, partially reinforcing the eardrum with cartilage and predominantly using an ossicle to perform the ossiculoplasty. Removing the malleus and reinforcing the whole tympanic membrane with cartilage statistically reduced the cholesteatoma recurrence rate for the ICW procedure. This technique, using hydroxylapatite prosthesis for ossiculoplasty gives good hearing results.

Introduction: Unilateral facial pain in the trigeminal area is known to be caused by a cancer in the superior lobe of the lung.

Case report: A 65 year old male, heavy smoker, presented a permanent otalgia and a mandibular pain on the left side. These symptoms could not be relieved by common analgesics. All explorations for common etiologies were negative. After an episode of dyspnea, a left lung cancer was discovered. Thanks to radiotherapy and chemotherapy, the patient's pain was improved.

Conclusion: Referred facial pain is rare and can be explained by the invasion of the tenth nerve by an upper lobe lung tumor. In most cases, the patient presents a right otalgia and pain in the area of V3. The diagnosis can be delayed from 1 month to 4 years after the onset of the pain. Referred facial pain is improved by the treatment of the causal lung cancer.

Decisions in cholesteatoma surgery regarding open versus closed techniques are based on the extent of the cholesteatoma, the degree of pneumatization of the middle ear and mastoid and the integrity of the remaining mucosa following complete resection of all disease. Checklists regarding handling of the soft tissues, drilling of the temporal bone with complete exenteration of the tympanomastoid air cell tracts, lowering of the facial ridge, partial obliteration of the cavity and meatoplasty and postoperative care are presented. Adhering to these checklists should enable every otologic surgeon to perform a safe open cavity and to end up with a dry, mostly self-cleaning cavity.

Introduction: In the past bilateral neck exploration was the gold standard for successful surgical management of primary hyperparathyroidism. More restricted procedures have been introduced recently thanks to imaging techniques and intraoperative parathyroid hormone assay confirming eradication of hyperfunctioning tissue.

Methods: Thirty patients operated for parathyroid adenoma were submitted to intraoperative PTH determination with Quick Pack immunochemiluminescent assay (Nichols lab.) prior to excision and 5, 10 and 20 minutes after removal of the presumed hyperactive gland. Eleven patients were operated on by a minimally invasive procedure with videoassistance.

Results: Response to excision of the hyperfunctioning gland was evidenced by a significant decrease of PTH levels (50% of initial value) in 26 patients. Plasma PTH levels decreased by at least 80% of pre-excisional value after 20 minutes, 70% after 10 minutes and by 50% after 5 minutes. In 2 cases, significant decrease of PTH was obtained after 45 and 60 minutes respectively. In 2 other cases, the adenoma could not be found and there was no decrease of PTH even after extensive exploration of the neck. In the 11 patients who underwent minimal invasive surgery, 2 were converted to open neck surgery: in one case the adenoma was not accessible in the upper part of the neck, in the other case the hyperfunctioning gland remained undiscovered.

Conclusion: intraoperative measurement of PTH should be considered a reliable and reproducible method for evaluation of the secreting activity of a parathyroid gland. The Quick Pack method has the advantage of confirming that the hyperactive gland has really been eradicated and consequently of considerably reducing operating time and avoiding extensive exploration of the neck.

J. Ramsay Hunt's hypothesis that herpes zoster oticus results from a reactivation of the herpes zoster virus in the geniculate ganglion, has been supported by the demonstration of varicella zoster viral DNA in the geniculate ganglion of the side with facial paralysis in patients with Ramsay Hunt syndrome, with the use of the polymerase chain reaction. Similarly, DNA of the varicella zoster virus has been identified in the spiral and vestibular ganglion as well. We report on three patients with cochleovestibular symptoms as the first manifestations of Ramsay Hunt syndrome. A 64-year old woman and a 72-year old man presented with vertigo and an auricular herpetiform eruption. Only the woman developed later on a mild facial paralysis. A 58-year old man presented with an acute cochleovestibular syndrome, serologically proven to be a varicella zoster viral reactivation, which was followed three weeks later by the typical cutaneous recrudescence. We believe that these cases result from reactivation of latent varicella zoster virus in the spiral and/or vestibular ganglion. As the varicella zoster virus is dormant in the non-neuronal satellite cells, the facial symptoms in our patients as well as the high incidence of cochleovestibular symptoms in classical Ramsay Hunt syndrome can be explained by viral transmission across the nerves inside the internal auditory canal. Therefore, we think there are grounds to recommend a prompt treatment with an antiviral and a corticosteroid agent, not only in case of an acute facial paralysis but also when confronted with an acute cochleovestibular syndrome.

Extracranial meningioma is an unusual tumor, mainly found in the head and neck area. Before surgical removal and histopathological examination, this diagnosis is rarely considered. We report a case of an extracranial meningioma located in the frontal sinuses of a 65-year-old-woman. Symptomatology included trouble of vision due to bilateral exophtalmos and mild headaches. Bilateral exophtalmos was secondary to the development of huge frontal mucoceles. These mucoceles grew slowly due to the frontal recesses blockage by the extracranial meningioma. External approach was performed with removal of the mucocele walls and of the extracranial meningioma itself. The frontal recesses were blocked with synthetic cement, and orbital roofs were reconstructed with a polydioxanon-sheet (PDS). Frontal sinuses were excluded and filled with bone bank grafts. A review of the literature on extracranial meningioma and a discussion about the surgical management of this case are proposed in this paper.

Objective: To assess the prognostic factors of recurrence in a cohort of patients operated on for polyposis by means of endonasal endoscopic surgery.

Methods: Prospective study of 227 patients operated on for polyposis in a single institution between 1993 and 2001. The mean follow-up period was 24 months (range 12 months to 60 months). Nine parameters were analysed to study their association with polyp recurrence: age, gender, smoking history, presence of asthma, allergy, non-steroidal anti-inflammatory drugs (NSAID) intolerance, recurrent sinusitis, previous nasal surgery, and polyp extension. Analysis of recurrences was accomplished using the Kaplan-Meier survival curves and differences were analysed using the log-rank test. The Cox proportional hazards model was used to estimate the effect of individual risk factors on polyp recurrence. A probability value of p < 0.05 was the level of significance selected.

Results: During the study period, recurrences developed in 55 patients, giving a rate of 24%. In the univariate analysis, NSAID intolerance, asthma, revision surgery and polyp extension were associated with recidivism. The other mentioned factors did not attain statistical significance. However, the multivariate analysis demonstrated that only NSAID intolerance and asthma are independent predictive factors for recurrence.

Conclusions: Patients presenting NSAID intolerance or asthma are at risk for the development of recurrences after endonasal surgery for nasal polyposis.

There is a complex functional organization of the central auditory system from the brainstem to primary and associative auditory cortices. Functional neuroimaging has been used to visualize and confirm the spatial distribution of brain activation in temporal areas for the processing of simple acoustic stimuli. Brain activity is much more complex for words, and different networks can be recruited when phonological, lexical and semantic levels of processing are engaged.